Are TB programmes responsible for poverty alleviation?

Alice Sagwidza-Tembe, CNS Correspondent, SwazilandComing back from the 47th Union World Conference on Lung Health held in Liverpool in October 2016, it is time to reflect upon the myriad advancements and debates to better the quality of care for people with TB—shortening the treatment schedule for multi drug resistant TB (MDR-TB), addressing the otherwise forgotten groups like adolescents, celebrities opening up about having lived with TB, and plenty more on fresh approaches to end the epidemic.
An interesting, but not so new aspect crept into every discussion—the socio-economic issues that dampen efforts to stop TB and that begged the question: Are national TB programmes responsible for eradicating poverty to ensure effectiveness of the TB treatment therapy? Speaking with Dr Samson Haumba, the Country Director at the University Research Company in Swaziland, he expressed, “The socio-economic needs of the patient are critical to the intervention. However, the National TB programme by itself cannot shoulder the eradication of poverty to improve the socio-economic state of a patient”. This is not a completely new phenomenon. HIV programmes too have had to deal with this concern when the life-saving antiretroviral therapy was introduced, noting that patients failed to recover not because they were not taking the medication but due to malnutrition. Further, the socio-economic issues became a barrier to treatment access and adherence. This is a similar experience in TB, particularly with extended long term therapy for MDR-TB. However, in a bid to avoid dual health systems and working in silos, TB programmes need to be effective in the mainstream health delivery system.

The highest burden of MDR-TB is in the low income countries that are resources stricken and fall short on social support systems for general populations. This reality implies that national TB programmes have to find ways and means to supplement patients and families for the sake of treatment success. Stepping into the conversation with Dr Haumba was Dr Miranda Brouwer, a Senior Consultant with Public Health Tuberculosis Consultancy and Training based in Netherlands. According to her, “…. the government is responsible for eradication of poverty, and no one programme, (whether TB or HIV programme) can afford do to that”. She explained that even if the TB programmes introduced social packages for patients on treatment, the patients might successfully complete the therapy and be cured of TB. But this would just be a temporary fix with no lasting effect on their quality of life, as they will still have to go back to live their lives with one or more other ailments. This is the stark reality of far too many patients.

Multi-sectorial approach

As with the HIV programmes, it is becoming apparent that a multi-sectorial approach will be required to respond effectively to TB, and in particular to MDR-TB. However, it seems to have become the norm that health intervention programmes and governments go out begging for funding and support to the manage health challenges in their countries. Seemingly, this approach leaves the problem in the hands of the passionately driven, yet frustrated, health programmes. Maybe it is time that the national TB programmes, instead of asking public and private stakeholders within and outside their countries for help, make an issue of the case, clarifying what every stakeholder stands to lose if TB continues to ravage us and what they need to do to protect their sector.

Governments will have no states to run if MDR-TB is left to reduce the lives of the citizens to poverty. The private sector will have no manpower and no pool of human resources to run their companies- hence no productivity and no profits. Essentially, the world could go into utter chaos. Let us remember that TB does not segregate its victims— not by socio-economic status, race, sex, creed, religion, political affiliation, age or geographic location. TB is an air-bone disease. It is therefore, in everyone’s interest to invest in combating TB and stopping it in its tracks for the sake of the whole human race.